Breast Cancer Oncotype Testing Medical Necessity Criteria
Reviewed: 3/10, 2/11, 1/12, 3/14, 2/15, 1/16, 1/17
Breast cancer oncotype testing quantifies the risk of breast cancer recurrence in women with newly diagnosed, Stage I or II, node negative, estrogen receptor positive breast cancer who will be treated with Tamoxifen. The following guidelines are used when considering oncotype testing requests:
The cancer is not metastatic beyond three regional nodes.
The tumor is estrogen receptorpositive and or progesterone receptor positive.
The tumor is HER2 receptor negative.
Adjuvant chemotherapy is not precluded due to other conditions such as advanced age or co-morbidities.
The patient and physician have discussed the value, limitations, and implications of the test.